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Another International Survey Confirms Cybersecurity Issues--Across All Industries

February 14, 2018
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A new survey of CISOs across all industries in the US and UK finds significant gaps in preparedness for the cybersecurity threats accelerating against all businesses

I was very interested to read a report that came out Tuesday in the online publication TechRepublic. That report relayed the results of a survey by RiskIQ, a San Francisco-based digital threat management solutions provider.

As Alison DeNisco Rayome noted in her article, entitled “Security nightmares: These 3 threats keep CISOs up at night,” “The barrage of cyberattacks that CISOs must diffuse on a daily basis show no signs of slowing: 89% of all information security leaders report concerns over the rise of digital threats their organizations are experiencing across web, social, and mobile channels, according to a new report from RiskIQ. According to the 1,691 US and UK CISOs surveyed for the report, the top threats keeping CISOs up at night are as follows: 1. Phishing and malware attacks on employees and customers 2. Brand impersonation, abuse, and reputational damage. 3. Information breaches.”

Further, in its announcement on Tuesday, RiskIQ had stated this: “RiskIQ, the leader in digital threat management, today announced the release of its 2018 CISO Survey, revealing that 89.1 percent of all information security leaders are concerned about the rise of digital threats they are experiencing across web, social and mobile channels. Some 1,691 U.S. and U.K information security leaders across multiple verticals, including enterprise, consulting, government and education, provided insights into their cyber risk concerns and plans for 2018. Overall,” the RiskIQ announcement noted, “the survey revealed a coming “perfect storm”, where the problem of staff shortages collides with escalating cybercrime, leaving organizations ill-equipped to manage and respond to cyber risks and threats that are accelerating in an era of digital transformation, pervasive connections and increasingly sophisticated attack strategies sponsored by nation-states and rogue actors.” And, it added, issues around the Spectre and Meltdown phenomena dominated the news in early 2018, and after a year of major security breach announcements and settlements, including Equifax, Yahoo and Anthem, concern over breaches should hardly be surprising.

Among the key findings of the RiskIQ survey of CISOs in the United States and United Kingdom, across all industries:

>  67 percent of cybersecurity leaders do not have sufficient staff to handle the daily barrage of cyber alerts they receive

>  60 percent expect digital threats to grow as their organizations increase online engagement with customers

>  The top three digital threats information security leaders fear are phishing and malware attacks on employees and customers; brand impersonation, abuse, and reputational damage; and information breaches

>  The top risk organizations face today is a lack of experienced staff to monitor and help protect networks from cybercrime

>  Currently, 37 percent of firms have engaged a managed security services provider (MSSP) to help monitor and manage cyber threats

In releasing his company’s survey, CEO Lou Manousos, said, “The RiskIQ 2018 CISO Survey illuminates a growing industry-wide problem, which is that cybercrime is growing at scale, and enterprises are already experiencing critical staff shortages. That’s one reason 1 in 3 organizations have engaged with an MSSP to combat cyber risks and threats, and we expect that number to grow as the competition for top security talent gets far more intense.”

We’re not alone in healthcare

So, what to make of all these results? Well, let’s see… First of all, it’s amazing how much commonality there is between and among different industries, when it comes to the cyberthreats and cybersecurity issues facing CISOs and other IT leaders, across different industries.

We really aren’t alone, in healthcare. And that’s both “good” and “bad.” What I mean by that is that, on a certain level, it’s very helpful and good to know that healthcare IT leaders are not alone in this struggle; they are not uniquely subject to the vast range of cybersecurity threats out there in the world. Indeed, virtually every business industry is facing the same broad outlines. Thus, there are CISOs in every industry that has information systems (which is very industry nowadays).

The numbers alone are chilling: the fact that “67 percent of cybersecurity leaders do not have sufficient staff to handle the daily barrage of cyber alerts they receive”; and the fact that “60 percent expect digital threats to grow as their organizations increase online engagement with customers,” are deeply concerning.

What’s more, I found this particularly fascinating: “The top three digital threats information security leaders fear are phishing and malware attacks on employees and customers; brand impersonation, abuse, and reputational damage; and information breaches.” Now, here’s where things get interesting, because while healthcare organizations face the same broad cyberthreats as other industries, it is also true that healthcare is particularly vulnerable in certain respects. That’s because, while phishing attacks can impact any type of business organization, patient care organizations are faced with the special vulnerability around protected health information (PHI), which is at the core of the data and information that they maintain and work with.

Certainly, of course, the breaching of any core personal information—Social Security numbers, credit card numbers, financial information—is a dangerous, and very bad thing. But as those who have been paying attention, know, the value to cybercriminals of personal health/medical information, is many times that of the value of, say, information gleaned from credit cards. And that means that the healthcare industry will continue to be more aggressively targeted, for certain types of information, than other industries.

What’s more, healthcare remains behind other industries in terms of gearing up effectively to meet these challenges.

Fortunately, innovative CISOs in U.S. healthcare are helping to lead their colleagues forward towards successful approaches to these issues. As Sriram (Sri) Bharadwaj, CISO at UC-Irvine Health in Irvine, California, told Managing Editor Rajiv Leventhal in an interview in December, “The cyber threat landscape has definitely changed. When I look at just the UCs (University of California organizations), or any of the hospitals in our vicinity, they have changed purely for two reasons. First, we have started investing in technologies that help address some of the typical threats that we have seen in our environment. Now, have they been mitigated or remediated? I don’t think so; the threats have morphed into something else now that really needs to be addressed. But if you take a technology that you can use to trap issues at the perimeter rather than at the desktop or endpoint level, now your risk or threat mechanism has shifted to the perimeter rather than to your internal environment. That doesn’t mean the risk has gone away, though.”

What’s more, Bharadwaj said, “Second, the insider threats have not gone away; they are becoming more sophisticated in that people are allowing insiders to come through by making an error or mistake where they didn’t know that the threat existed. So you need more intelligent tools to actually understand the threat and then take measures to mitigate it.” And, in that regard, he said, in response to a question about the strategies that he and his colleagues have been implementing at UC Irvine Health, “The biggest strategy we have implemented is a culture of security awareness. That’s the biggest thing we have done for quite some time now. The level of engagement we have from leadership has shifted from ‘It’s a security issue’ to ‘I need to inform someone so that this doesn’t impact my organization.’ That shift has helped us mitigate some of the risks we see at the insider threat level.”

And, as was discussed in San Diego on February 2, we’re collectively learning from such global attacks as “WannaCry” and “PETYA/NotPETYA.” At our Healthcare Informatics Health IT Summit in San Diego two weeks ago, UC Irvine Health’s Bharadwaj led an excellent panel discussion around these issues.

In that discussion, Stan Banash, CISO of Children’s Hospital of Orange County (Orange, Calif.), said, “The key questions are, are you managing your risk? Do you understand your attack surfaces? What vectors are you vulnerable to? When this started out, no one knew what was going on; it was crazy. If you had one of those maps in your security center, it was all lit up, and it looked like ‘War Games.’ Initially, we thought it was via email, and we were chasing emails, but when we found out it was SMB vulnerability, we were able to chase that down. We were hit, but there was no successful attack on us. But understanding what was in your environment—it never became more important than on that day. And those MRI machines running on Windows XP—those machines are million-dollar pieces of equipment; it’s hard to justify new purchases to the board. I would say we were lucky; I’d like to say we manage things well, but we did get lucky.”

What’s more, CISOs and their colleagues in patient care organizations are connecting more and more with law enforcement officials, in order to move forward to meet these challenges. Asked on the panel about connections with law enforcement, Christian Abou Jaoude, director of enterprise architecture and Scripps Health (San Diego), said, “We do have a direct contact with law enforcement; we also have a protocol that we follow that’s been well-established. We followed those procedures, but the same thing happened to us: there wasn’t much information available during the first couple of days” following the WannaCry attack. “So I went out and read as much as I could about it, read articles to see whether there was something different about this. So we enacted that process, sent out notifications, and then a few days later, everyone learned what had happened.”

In the end, the reality is that the broad set of cybersecurity challenges facing patient care organizations—and all business organizations in all countries—will continue forward, simply because, unfortunately, there will always be cyber-criminals eager to wreak havoc on the information systems of all business organizations. The good news? CISOs and their colleagues in healthcare, like the CISOs and their colleagues in other industries, are learning and adapting. They’ll always be catching up with the bad guys, but one can only hope that, a few years from now, in response to questions in surveys like that sponsored by RiskIQ and reported on by publications like TechRepublic, most IT security leaders will be able to answer more confidently about their capabilities and preparedness in this critical area.



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Healthcare’s “RegTech” Opportunity: Avoiding a 2008-Style Crisis

September 21, 2018
by Robert Lord, Industry Voice, Co-Founder and President of Protenus
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In the financial crisis of 2007 to 2009, the financial industry suffered a crisis of trust. A decade later, banks and other financial institutions are still working to regain the confidence of consumers and regulators alike. In 2008 and 2009, while working at one of the world’s top hedge funds, I had a front-row seat to the damage that occurred to our economy, watching as storied corporate institutions fell or were gravely damaged. Today, as co-founder of a health technology company, I see healthcare is approaching a similarly dangerous situation. We must get ahead of the curve to avoid disaster.

Like finance, healthcare is a highly-regulated industry where non-compliance can result in severe financial and reputational consequences for healthcare companies, and severe impact on people’s lives. We deal with HIPAA, MACRA, HITECH, and hundreds of other foreboding acronyms on a daily basis. A lot of attention goes to the terrific and important work of clinical decision support, wellness apps, and other patient care technologies, but problems in the back office of hospitals must be addressed as well. One of these problems is the amount and complexity of healthcare regulation, and our healthcare system’s inability to keep up.

In finance, where I spent the early part of my career, the adoption of what is termed “RegTech” (regulatory technology) was driven by the increasing complexity of financial technology and infrastructure sophistication.  As trades moved faster, and as algorithms, processes and organizations became more complex, the technologies needed to ensure regulatory compliance had to move in tandem.  The crisis we experienced in 2008 was partially the result of the inability of the industry’s regulatory capabilities to keep up with the pace of technological change.  In many ways, the industry is still playing a catch-up game.

As healthcare professionals, looking to the lessons learned by our colleagues in finance can help us predict patterns and stay ahead of the curve. Right now, I’m seeing alarming parallels to challenges faced in finance a decade ago.


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Robert Lord

The burden of regulation across our industry is simply staggering.  Thirty-nine billion dollars of regulatory burden is associated with healthcare annually, which is about $1,200 per patient, per year. Despite this high cost, we still have $1 trillion of fraud, waste and abuse in our healthcare system. With so much regulation, why are we seeing so little yield from that burden? In many cases, it’s because we’re merely checking boxes and not addressing core risks؅. Like finance, there was a great deal of effort on compliance with regulations, but not enough attention on addressing important systemic risks.

This is not to say I am against good regulation; in fact, many regulations serve to protect patients and improve care. The problem is that there are so many demands on healthcare systems, that compliance and regulation is often reduced to checking boxes to ensure that minimum defensible processes are built, and occasionally spot-checking that things look reasonable. We currently have nowhere near 100 percent review of activities and transactions that are occurring in our health systems every day, though our patients deserve nothing less. However, unless overburdened and under-resourced healthcare providers and compliance professionals can achieve leverage and true risk reduction, we’ll never be able to sustainably bend our compliance cost curve.

Systemic problems are often not discovered until something goes horribly wrong (e.g., Wall Street every decade or so, the Anthem data breach, etc.). Today In the financial industry, RegTech provides continual, dynamic views of compliance or non-compliance and allows management, compliance professionals and regulators to check compliance in real-time. They can view every record, understand every detail, and automate investigations and processes that would otherwise go undetected or involve lengthy and labor-intensive reviews.

The real promise of these new capabilities is to allow compliance professionals and regulators to perform the truest form of their jobs, which is to keep patient data secure, ensuring the best treatment for patients, and creating sustainable financial models for healthcare delivery. RegTech will open up lines of communication and help create conversations that could never have been had before—conversations about what’s not just feasible for a person to do, but what’s right to do for the people whom regulation seeks to protect.

No longer bound by limited resources that lead to “box-checking,” compliance officers can use new and powerful tools to ensure that the data entrusted to them is protected. At the same time, healthcare management executives can be confident that the enterprises they manage will be well served by risk reducing technological innovation.  Patients, the ultimate beneficiaries of healthcare RegTech, deserve as much.

Robert Lord is the co-founder and president of Protenus, a compliance analytics platform that detects anomalous behavior in health systems.  He also serves as a Cybersecurity Policy Fellow at New America.


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HIPAA Settlements: Three Boston Hospitals Pay $1M in Fines for “Boston Trauma” Filming

September 20, 2018
by Heather Landi, Associate Editor
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Three Boston hospitals that allowed film crews to film an ABC documentary on premises have settled with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) over potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

According to OCR, the three hospitals—Boston Medical Center (BMC), Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH)—compromised the privacy of patients’ protected health information (PHI) by inviting film crews on premises to film "Save My Life: Boston Trauma," an ABC television network documentary series, without first obtaining authorization from patients.

OCR reached separate settlements with the three hospitals, and, collectively, the three entities paid OCR $999,000 to settle potential HIPAA violations due to the unauthorized disclosure of patients’ PHI.

“Patients in hospitals expect to encounter doctors and nurses when getting treatment, not film crews recording them at their most private and vulnerable moments,” Roger Severino, OCR director, said in a statement. “Hospitals must get authorization from patients before allowing strangers to have access to patients and their medical information.”

Of the total fines, BMC paid OCR $100,000, BWH paid $384,000, and MGH paid $515,000. Each entity will provide workforce training as part of a corrective action plan that will include OCR’s guidance on disclosures to film and media, according to OCR. Boston Medical Center's resolution agreement can be accessed here; Brigham and Women’s Hospital's resolution agreement can be found here; and Massachusetts General Hospital's agreement can be found here.

This is actually the second time a hospital has been fined by OCR as the result of allowing a film crew on premise to film a TV series, with the first HIPAA fine also involving the filming of an ABC medical documentary television series. As reported by Healthcare Informatics, In April 2016, New York Presbyterian Hospital (NYP) agreed to pay $2.2 million to settle potential HIPAA violations in association with the filming of “NY Med.”

According to OCR announcement about the settlement with NYP, the hospital, based in Manhattan, violated HIPAA rules for the “egregious disclosure of two patients’ PHI to film crews and staff during the filming of 'NY Med,' an ABC television series.” OCR also stated the NYP did not first obtain authorization from the patients. “In particular, OCR found that NYP allowed the ABC crew to film someone who was dying and another person in significant distress, even after a medical professional urged the crew to stop.”

The OCR director at the time, Jocelyn Samuels, said in a statement, “This case sends an important message that OCR will not permit covered entities to compromise their patients’ privacy by allowing news or television crews to film the patients without their authorization. We take seriously all complaints filed by individuals, and will seek the necessary remedies to ensure that patients’ privacy is fully protected.” 

OCR’s guidance on disclosures to film and media can be found here.

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Independence Blue Cross Notifies 17K Patients of Breach

September 19, 2018
by Rajiv Leventhal, Managing Editor
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The Philadelphia-based health insurer Independence Blue Cross is notifying about 17,000 of its members that some of their protected health information (PHI) has been exposed online and has potentially been accessed by unauthorized individuals.

According to an article in HIPAA Journal, Independence Blue Cross said that its privacy office was informed about the exposed information on July 19 and then immediately launched an investigation.

The insurer said that an employee had uploaded a file containing plan members’ protected health information to a public-facing website on April 23. The file remained accessible until July 20 when it was removed from the website.

According to the report, the information contained in the file was limited, and no financial information or Social Security numbers were exposed. Affected plan members only had their name, diagnosis codes, provider information, date of birth, and information used for processing claims exposed, HIPAA Journal reported.

The investigators were not able to determine whether any unauthorized individuals accessed the file during the time it was on the website, and no reports have been received to date to suggest any protected health information has been misused.

A statement from the health insurer noted that the breach affects certain Independence Blue Cross members and members of its subsidiaries AmeriHealth HMO and AmeriHealth Insurance Co. of New Jersey. Fewer than 1 percent of total plan members were affected by the breach.

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